APPENDIX 2

Photochemotherapy with oral or topically applied psoralens, usually 8-methoxypsoralen (8-MOP), and UVA is a widely accepted treatment modality for various chronic inflammatory and lymphoproliferative skin disorders, such as eczema and psoriasis.1 We prescribed a thrice-weekly home PUVA treatment to a 54 year old man (weight 81 kg) with severe disabling tylotic hand eczema. The treatment consisted of a commercially available UVA bronzing unit and 50 mg of 8-MOP. The formulation used was Geroxalen®. Pre-treatment laboratory evaluation of blood and urine samples for renal, liver and haematological parameters revealed no abnormalities. Between one and two hours after taking the 8-MOP, along with a meal, the patient experienced nausea and dyspepsia, which increased in severity after every subsequent intake and lasted for about 20 to 30 hours. We then recommended that he use acetaminophen and reduce his 8-MOP dose to 2 x 20 mg with a 15 minute interval, but the change in his regimen was of no benefit. After the fifth administration of 8-MOP he rapidl